5 ms·

Large imaging study confirms brain differences in ADHD

41 points by devinp 10y ago

blakesterz 10y ago
Interesting quote: "The different volumes of the five brain regions involved in ADHD were present whether or not people had taken medication, suggesting the differences in brain volumes are not a result of psychostimulants."
6stringmerc 10y ago
Okay so now an MRI brain scan will be par-for-the-course for children thought to be experiencing ADHD symptoms in advance of prescribing medication, right? Seems reasonable. Otherwise how else can one objectively note whether an ADHD "brain issue" is at fault or, uh, simple emotional adaptive recalcitrance?
- agentgt 10y ago
  I'm fairly certain most experts can tell the difference and not all experts are for prescribing medicine either (I believe John Ratey is fairly against it). Being disobedient does not mean ADHD (and of course the inverse) and there different expressions of ADHD as well (like the passive wondering mind version of which I have). Unfortunately the mass public (and apparently you as well based on your comment) associate hyperactive disobedient behavior with ADHD.
- deleted 10y ago
  [deleted]
- wyldfire 10y ago
  That's pretty unlikely IMO. Physicians are remarkably pragmatic. Diagnostic imaging tools like CT and MRI were created in order to avoid the risk of exploratory surgery. As a byproduct, they are also useful in medical research applications like these. From the article: > “We hope that this will help to reduce stigma that ADHD is ‘just a label’ for difficult children or caused by poor parenting." In general, diagnostic imaging is funded to mitigate some other downstream risk. "Would the wrong treatment be harmful?" [not in this case, popular treatment is pharmeceutical - psychostimulants, pretty safe drugs]. "Would delaying diagnosis of a non-ADHD disease be harmful?" [not likely given the symptoms]. If you had an extraordinary case ("Patient is allergic to psychostimulants and alternative treatment X is expensive or risky"), this research might be used to convince the relevant parties that an MRI to rule-out ADHD is worthwhile.
- indolering 10y ago
  AFAIK, fMRI scans are rarely of diagnostic utility in psychiatric disorders due to individual variances. Seriously, where you process parts of speech floats around in different places. Functional Magnetic Resonance Imaging is like taking a heat map of a CPU, they have become high resolution but you can only figure out what functional components of the CPU have been active after a circuit has been running for a very long time. Then you have the arduous task of reverse engineering the algorithm running on that wetware. Now throw in a bunch of variables such as age.... Things might have changed, but we are still a long way out.
SEJeff 10y ago
Being an extremely hyperactive child (whom my mother refused to medicate and instead just disciplined me often), I always knew I was different. Not special different, just different in an annoying hard to fit in way. I find it interesting the "sides" in this debate when other studies also find entirely different brain chemistry in ADD/ADHD (whatever the flavor of the day to call it is). People with this demeanor tend to gravitate very heavily towards engineering / technology related fields and excel, although I never understood why. The way I describe it to most people is very simple. If you give a ADD/ADHD child Ritalin, Adderol, etc, they will calm down. You give those drugs to a normal child and they get super hyperactive. Inversely, you give most people a stimulant such as caffeine and their heart beat increases and they perk up. I've always been very careful about coffee in the morning or teas as it is very much a calming downer. Sometimes I will drink a coffee to really calm my (always thinking too much) brain and let me focus, but can't do it if I'm the least bit tired as I'll be more inclined to doze off mid day. I'm happy to see more actual science that shows this is a real thing, not something made up by an impatient child or child who had lots of trouble paying attention in school. EDIT: Removed the first paragraph where I was thankfully wrong. Thanks geoelectric and filoeg for beating me with the cluebat, it is appreciated.
- filoleg 10y ago
  Are you sure that it is the case? I tried looking into it, and it seems like DSM 5 still has ADHD as a separate disorder, non-related to autism spectrum http://images.pearsonclinical.com/images/assets/basc-3/basc3resources/DSM5_DiagnosticCriteria_ADHD.pdf http://images.pearsonclinical.com/images/assets/basc-3/basc3...
  - SEJeff 10y ago
    Edited to correct this, thanks for calling me on it. I'm glad I was wrong.
- geoelectric 10y ago
  Think you're confusing what happened to Asperger's--it was redefined as a spectrum variation rather than its own thing. In fact, DSM4 didn't allow simultaneous autism and ADHD diagnoses and DSM5 does.
indolering 10y ago
How did this get so high up on HN? This is in no way a breakthrough. The volume of scans and age ranges help nail down etiology, but the article and commentary here suggest that we didn't know what brain structures were involved or that ADHD is a "brain based disorder." We've been doing MRI research on ADHD for decades[0] and independent longitudinal studies that track ADHD children into adulthood[1]. [0]: http://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.2012.11101521 http://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.201... [1]: http://www.guilford.com/books/ADHD-in-Adults/Barkley-Murphy-Fischer/9781609180751/authors http://www.guilford.com/books/ADHD-in-Adults/Barkley-Murphy-...

41 points by devinp 10y ago

Interesting quote: "The different volumes of the five brain regions involved in ADHD were present whether or not people had taken medication, suggesting the differences in brain volumes are not a result of psychostimulants."

6stringmerc 10y ago

Okay so now an MRI brain scan will be par-for-the-course for children thought to be experiencing ADHD symptoms in advance of prescribing medication, right? Seems reasonable. Otherwise how else can one objectively note whether an ADHD "brain issue" is at fault or, uh, simple emotional adaptive recalcitrance?

agentgt 10y ago
I'm fairly certain most experts can tell the difference and not all experts are for prescribing medicine either (I believe John Ratey is fairly against it). Being disobedient does not mean ADHD (and of course the inverse) and there different expressions of ADHD as well (like the passive wondering mind version of which I have). Unfortunately the mass public (and apparently you as well based on your comment) associate hyperactive disobedient behavior with ADHD.
deleted 10y ago
[deleted]
wyldfire 10y ago
That's pretty unlikely IMO. Physicians are remarkably pragmatic. Diagnostic imaging tools like CT and MRI were created in order to avoid the risk of exploratory surgery. As a byproduct, they are also useful in medical research applications like these. From the article: > “We hope that this will help to reduce stigma that ADHD is ‘just a label’ for difficult children or caused by poor parenting." In general, diagnostic imaging is funded to mitigate some other downstream risk. "Would the wrong treatment be harmful?" [not in this case, popular treatment is pharmeceutical - psychostimulants, pretty safe drugs]. "Would delaying diagnosis of a non-ADHD disease be harmful?" [not likely given the symptoms]. If you had an extraordinary case ("Patient is allergic to psychostimulants and alternative treatment X is expensive or risky"), this research might be used to convince the relevant parties that an MRI to rule-out ADHD is worthwhile.
indolering 10y ago
AFAIK, fMRI scans are rarely of diagnostic utility in psychiatric disorders due to individual variances. Seriously, where you process parts of speech floats around in different places. Functional Magnetic Resonance Imaging is like taking a heat map of a CPU, they have become high resolution but you can only figure out what functional components of the CPU have been active after a circuit has been running for a very long time. Then you have the arduous task of reverse engineering the algorithm running on that wetware. Now throw in a bunch of variables such as age.... Things might have changed, but we are still a long way out.

SEJeff 10y ago

Being an extremely hyperactive child (whom my mother refused to medicate and instead just disciplined me often), I always knew I was different. Not special different, just different in an annoying hard to fit in way. I find it interesting the "sides" in this debate when other studies also find entirely different brain chemistry in ADD/ADHD (whatever the flavor of the day to call it is). People with this demeanor tend to gravitate very heavily towards engineering / technology related fields and excel, although I never understood why. The way I describe it to most people is very simple. If you give a ADD/ADHD child Ritalin, Adderol, etc, they will calm down. You give those drugs to a normal child and they get super hyperactive. Inversely, you give most people a stimulant such as caffeine and their heart beat increases and they perk up. I've always been very careful about coffee in the morning or teas as it is very much a calming downer. Sometimes I will drink a coffee to really calm my (always thinking too much) brain and let me focus, but can't do it if I'm the least bit tired as I'll be more inclined to doze off mid day. I'm happy to see more actual science that shows this is a real thing, not something made up by an impatient child or child who had lots of trouble paying attention in school. EDIT: Removed the first paragraph where I was thankfully wrong. Thanks geoelectric and filoeg for beating me with the cluebat, it is appreciated.

filoleg 10y ago
Are you sure that it is the case? I tried looking into it, and it seems like DSM 5 still has ADHD as a separate disorder, non-related to autism spectrum http://images.pearsonclinical.com/images/assets/basc-3/basc3resources/DSM5_DiagnosticCriteria_ADHD.pdf http://images.pearsonclinical.com/images/assets/basc-3/basc3...
- SEJeff 10y ago
  Edited to correct this, thanks for calling me on it. I'm glad I was wrong.
geoelectric 10y ago
Think you're confusing what happened to Asperger's--it was redefined as a spectrum variation rather than its own thing. In fact, DSM4 didn't allow simultaneous autism and ADHD diagnoses and DSM5 does.

indolering 10y ago

How did this get so high up on HN? This is in no way a breakthrough. The volume of scans and age ranges help nail down etiology, but the article and commentary here suggest that we didn't know what brain structures were involved or that ADHD is a "brain based disorder." We've been doing MRI research on ADHD for decades[0] and independent longitudinal studies that track ADHD children into adulthood[1]. [0]: http://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.2012.11101521 http://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.201... [1]: http://www.guilford.com/books/ADHD-in-Adults/Barkley-Murphy-Fischer/9781609180751/authors http://www.guilford.com/books/ADHD-in-Adults/Barkley-Murphy-...